It’s not hard to criticize the actions of Dr. Jack Kevorkian. Certain words easily come to mind: flamboyant, exhibitionistic, morbid, and reckless. After the infamous video that he gave to CBS TV to air, the one that showed him directly causing the death of an ALS victim by lethal injection, I fired off an OP/ED to a newspaper and an opinion letter to a local medical society. I felt Kevorkian "had pushed the wrong envelope" by demonstrating
euthanasia on national TV instead of Physician-Assisted Suicide (an act for which he had been previously found NOT guilty three times).
Looking more closely at his clincal behavior, I was not alone in pointing out how Kevorkian seemed to act in "crisis mode" to end people's lives. Sometimes, he failed to follow the guidelines he had designed himself. Without adequate safeguards for his (quote) “patients,” it is likely that he killed some patients who were not terminally ill. Why did he choose euthanasia for Tom Youk, a method that was clearly illegal so that committing it would very likely be considered crime? Presumably because the patient was paralyzed so he could not put pills in his mouth or turn a switch. Although the novel, Lethal Choice, reveals how computer technology can overcome paralysis, there was also a low-tech legal alternative that would have permitted Mr. Youk to choose to end his suffering without sending Kevorkian to prison. Severely disabled people can Voluntarily Refuse Food & Fluid. Death by dehydration can be comfortable, even peaceful, and it is legal as long as the patient is mentally competent.
Voluntary Refusal of Food and Fluid provides competent people with the opportunity to change their minds over the first several days of their fast. The first three to five days (of what is usually a total of two weeks) is characterized by lucidity when this precious time can be used for healing goodbyes. In addition, the patient can continue to ask if there is any meaning and purpose still remaining in their lives. One patient changed her mind twice and wrote several more birthday cards to her young daughter for a dozen years in the future.
Not operating in crisis mode and providing an extensive medical, psychological, and spiritual evaluation before the "ultimate" decision is made has the potential to extend quality of life. By emphasizing the responsibility to make a diligent decision, all concerned show respect for the sanctity of life. In contrast, acting in haste as if the patient were desperate for a quick solution can lead to the tragedy of premature dying.
In the case of Thomas Youk, he might have benefited from medical treatment and oxygen for his breathing anxiety and enjoyed a few more months of living to explore any remaining spiritual or relationship issues -- himself, and with the people he loved.
The greatest tragedy is to die prematurely when some quality of life still remains.
The tragedy of premature dying also applies to Kevorkian’s first patient. Janet Adkins was only 54 when Kevorkian interviewed her for less than two hours. Medical experts at Kevorkian’s Physician-Assisted Suicide trial testified that she might have had three years before her dementia became severe. Certainly, she still had some quality of life left. She had just won a full set of tennis with her son, even though she could not keep score. She was worried about the future. I doubt that Kevorkian factored into Mrs. Adkins' request to die how depressed she was. Her losses from early dementia included the ability to read, to teach, and to play piano. She also new she had a dismal future. But if she had been treated for her unrecognized depression and given the assurance that she would not have to merely exist in end-stage dementia, then it is possible that she might have enjoyed living another two or three years.
What kind of assurance would she need? That she could trust her authorized Proxy to refuse Food & Fluid if and when she reached a behavioral state in her dementia that she would no longer with to live.
While Kevorikian's state of Michigan subsequent made Physician-Assisted Suicide illegal, and much effort and money has been spent by activists to legalize the practice, the alternate legal method of Voluntary Refusal of Food & Fluid would have allowed Kevorkian’s “patients” an extended quality of life rather than dying prematurely and it would also have kept Kevorkian out of prison.
Now is the time for educating people who ask for help to die about Voluntary Refusal of Food & Fluid. This method to hasten dying is available to thousands of times more people than Physician-Assisted Suicide or euthanasia, including physically disabled people like Thomas Youk and mentally disabled people like the millions with end-stage dementia. In fact, diligent planning to create a strategic Proxy Directive, which gives a trusted person Power of Attorney to Refuse Food & Fluid when certain behavioral criteria of advanced dementia are reached, may be the only way to avoid the horrible, degrading, total dependency and huge human and financial burdens of end-stage dementia.
Some people argue in support of Dr. Kevorkian. They claim the medical profession and legislators needed his stunts (calling the police to discover a body in his “Death-Mobile,” an old rusty VW van). They argue that the medical professional needed a jolt to respond to one of our greatest fears: to die in prolonged pain and suffering just because it is illegal for physicians to respond to their patients’ requests to end their suffering permanently. In the last sixteen years, the percentage of terminally ill people enrolled in hospice increased, as did the numbers of doctors who took extra training to provide better end-of-life care. Those who see Kevorkian as a saint believe there is some degree of cause and effect operating here. (I will venture no guess let alone judgment on this point, but I will admit that passive refusal of food and fluid may not have been dramatic or newsworthy enough, compared to the 130 spectacles that Kevorkian provided.)
Respect for the sanctity of life requires us to be diligent in our decisions as well as compassionate. I feel it would be compassionate to release Dr. Kevorkian now rather than in June. After all, he has served seven and a half years, is 79, ill with active hepatitis C, diabetes, and high blood pressure, and thus may be approaching the terminal phase of his own life. His promise not to assist any one's dying is most likely mute since his potential for influence is long past.
The moral, clinical, legal, and political controversies in this challenging field are far from over, however. One point needs particular emphasis:
Life’s most ironic fact is that, when people know they can control when they die—they can, and often do—choose to live longer.
The book, The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life offers detailed strategies to avoid our two greatest end-of-life fears: A) To endure prolonged pain and suffering; and, B) To merely exist in a state of total indignity and dependency such as in Alzheimer’s dementia. More than a how-to-book, it introduces the noble goal to respect the sanctity of many lives.
